NPI | 1740627553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28139) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034822) |
Enumeration Date | 2013-06-03 |
Last Update Date | 2013-06-03 |